OVARIOTOMY PERFORMED ON THE ANTI SEPTIC METHOD, THE PATIENT BEING IN A STATE OF PYREXIA ; RECOVERY.

381 same female, needlessly excited or abused....... If it should happen that an; sufficient, and even do occasion the appearance of rabies excited dog bites anyone, the person who excited it should. in them.......... The incessant competition, the extreme ex- be held guilty of a legal offence,"and, in point of fact, he is citement, and the savage fights among amorous dogs in so by the Austrian and French, and should be equally so by rut have been decided upon as sufficient theEnglish law; for there would appear to be cases of latent. pursuit of a female in rabies, where the disease is stimulated into full developto pedispose, them to madness." 11 But precdisposition is not the disease itself, though it is ment, or where its dangerous symptoms are developed, only, of quite as great importance, because if it were more attended on or by man’s interference. Thus we are told that fury, to there would necessarily be much less rabies. As illus- even in the rabietic dog, is usually due to provocation or trations of predisposition to, or of the predisposing causes of excitement of a preventable kind .20 Professor Saint-Cyr, of rabies, all keepers of dog pets should be made aware of the Lyons, mentions a dog whose rabidity was not suspected fact that " Dogs kept only for luxury are the most dan- till "on its owner scolding it, it flew at and bit him." It de Lrcxe kept in apartments, petted, subsequently proved that it " had employed itself pulling gerous.......The dogs and whose venereal appetites are in- shavings about a joiner’s shop for two days, and no attenand abundantly fed, completely or never gratified," are the most liable to rabies; tion had been paid to this singular but significant occupadogs "belonging to irritable or nervous breeds, tion,"21 an occupation generally supposed by veterinarians to be illustrative of that morbid appetite which is one of the or else dogs which, having been kept all their lives chained up, have become very vicious......insufficiently exercised, few diagnostic signs of rabies. A rabietic pig " could and seldom allowed to gratify their sexual propensities,"are scarcely be made to move, even by beating; if any specially predisposed.12 "It is noteworthy,"says a New white body was placed before it, such as a piece of paper York newspaper in 1874, "that in every instance in which tied to a long stick, it immediately sprang up in a furious persons bitten by mad dogs during the last six months in state...... appearing to be very much agitated. Every time this city have died of hydrophobia, the dog inflicting the the experiment was made, the same effect was produced."2 wound has been a household pet. The streetl3 dogs have Rabies has repeatedly been produced intentionally for

consequent on several (males) competing for the

are

and, again,

but

inoculated no one with hydrophobia, so far as is known. It is the house dogs of the male sex, who are overfed and forced to lead an unnatural life, who become mad and communicate hydrophobia. "14 In reference to similar occurrences in our own country, Youatt exclaims, " We pity, or almost detest, the folly of those by whom their favourites are indulged and spoiled, even more than their own children."’ The latter clause, however, is surely unnecessary, inasmuch as pet dogs are almost invariably kept by women who have no children on whom to lavish their overfloivino, "maternal instinct." Further "excitement, anger, sexual irritability, terror,...... assist in the production of rabies."16 The effect of mere confinement to a house was well exhibited in the case of a certain tamed wild cat, which never slept in a certain house. " We compelled her to do so once," says Miss Clara Rossiter, in her " Anecdotes of Pets," "and the poor creature was so ill we did not attempt to do it again." Confinement, in association with solitude, silence, and darkness, is an apt cause of certain forms of insanity, especially melancholia with panphobia. We are told moreover that " confinement is almost certain in many dogs to produce skin disease; and it predisposes young dogs to convulsive and rheumatic attacks. " 17 It would appear also that physical pain, however produced, is occasionally both a direct and predisposing cause of rabies. " Extreme pain or intense suffering,"is credited with the production of rabies in such a case as the following : A castrated animal, on its return home, " retired to a corner of the house, refusing all kinds of food." It became gradually "irritable and morose, threatening to bite the farm people it had previously been fond of." Then it attempted to " bite some cattle, and could not be driven back by its master’s voice nor by threatenings with a stick." Subsequently it bit a horse and five cattle, all of which died of rabies. Fleming suggests that if mere pain could produce rabies, how comes it that the disease is so rare, while its alleged cause is so frequent ?18 This brings up as before the question of predisposition, of immediate as contrasted with remote causes, a question too wide, however, to be here or at present entered upon. The really important practical matter is that certain influences or causes, be they remote or immediate, predisposing or exciting, conduce to the production of rabies in the dog and other animals; that the operation of these influences can easily be prevented by man, and that it should be prevented. In other words, just as rabies is, frequently at least, produced by man, it is equally, in certain cases, preventable by him. There is a grave responsibility, then, if its generation de novo or its propagation is not prevented. Above all things,"says Fleming,19 "dogs should not be H Fleming: Rabies,

p. 116.

12

Ibid.,

p. 107.

This is borne out by the experience of Constantinople, and other Eastern cities, in which street dogs abound, but in which nevertheless rabies and are unknown. Asquoted in the North British Daily Mail (of Glasgow), July 31st,

14.]; Work 15.

on The Dog, p. 146. Flerning : Rabies, p. 173.

17. 18

hydrophobia

Article

Rabies,

on

"Rabies,"

pp. 113-14.

British Medical 19

Ibid.,

I Journal, July llth, 1874, p. 352.

experimental purposes by man ; but it does not follow that. experimenters in such cases were physicians. Moregenerally they have been veterinarians-authorities pre-, sumably competent to deal with such experiments both in their method and aim. In a guinea-pig artificially inoculated. the

with man’s saliva, the animal’s "violence induced convulsions of his whole frame, and they might be produced at by dashing a little water at him. "23 Maupertius produced hydrophobia in the dog by subjecting it to the bite of an irritated scorpion, says Pierquin ; but he pertinently puts the question whether an ordinary bite of the non-irritated animal would not have produced a similar result, and whether the result was really hydrophobia. He makes the suggestion in connexion with the fact that animal bites are fatal sometimes by tetanus or other diseases, and that irritation or passion may add to the malignity of a bite. " The dying bite of a beast of prey is always the worst," says Sir A. Alexander.24 (To be continued.)

pleasure

OVARIOTOMY PERFORMED ON THE ANTI SEPTIC METHOD, THE PATIENT BEING IN A STATE OF PYREXIA ; RECOVERY. BY

JOHN

WILLIAMS, M.D.,

ASSISTANT OBSTETRIC PHYSICIAN TO UNIVERSITY COLLEGE HOSPITAL.

THE notes of the following case were taken by Mr. R. S. Miller, late obstetric physician’s assistant. Mrs. D-, who had had two children, was seen by Mr. Keele, of Highbury, in August, 1876. She complained of a severe pain in the left inguinal region ; it had come on suddenly, and was greatly relieved by sedatives and hotapplications. On examination the uterus was found somewhat enlarged, and a diagnosis of pregnancy was madeThe abdomen grew rapidly until March, 1877, when Dr. Glover saw her in consultation with Mr. Keele. Pregnancycomplicated by an ovarian tumour was diagnosed, and: labour induced. A male child of six months was soon born, and the patient recovered well from the effects of the labour. Before delivery the abdomen measured fifty-two inches in circumference, after delivery forty-seven inches. The tumour 3rd she was tapped, when thirty grew rapidly, and on April pints of thick grumous fluid were drawn off. She rapidly improved, and at the end of May was able to walk out. The cyst, however, began to fill again, sickness set in and became very distressing, the temperature rose, and on Aug. 16th she was again tapped, when fifteen pints of thick grumous fluid were drawn off. Though relieved from the effects of pressure, she did not improve, for the sickness increased, the temperature continued high and once rose to 104°, she had much,, 20 21

23

24

Fleming, Rabies, p. 229. Ibid., foot-note, p. 237.

Youatt

Dog,

22

Ibid., foot-note, p. 281.

the p. 149. As quoted in Anderson’s Lion and on

Elephant, p.

148.

382

losing flesh, and exhaustion was increasing ; so on tying a cord round the bowel, and the O’Beirne tube passed pain, was 13th she was taken into University College Hospital. in. The point of the tube did not touch the stricture, but, admission, pulse was very feeble, 120 a minute, weak travelling along the free border of the bowel, impinged at a On and with and on the anterior surface

Sept.irregular ;

respiration 50, shallow,

102° F.

slightly

perpendi-

cular to the stricture, and carried that part of the bowel over with it. The tube being moved up and down a few times, as if adjusting or trying to get through the stricture, the external coat of the bowel gave way as a longitudinal split, and hernia of the inner coats took place. Hardly any pressure was exercised, and the only force really transmitted was that of the withdrawal and adjustment of the tube. Repetition of the experiment gave the same invariable result, and I am inclined to advocate that no tube or bougie longer than six inches be passed into the bowel. Glasgow.

A Mirror OF

HOSPITAL BRITISH

PRACTICE,

AND

FOREIGN.

inter

pulse

ON THE USE OF THE O’BEIRNE TUBE IN OBSTRUCTION OF THE BOWELS. BY J. STUART

superior

frequent sighing; point

Urine scanty, acid, depositing a large contains no albumen or sugar. of urates; quantity Abdomen large, pendulous ; lower part of wall shining and cedematous. On Sept. 15th the tumour was removed under carbolic-acid spray. All instruments, ligatures, &c., used were placed in a solution (one in forty) of carbolic acid, and the hands of all in the operation were washed in a similar solution. An helping incision from four to five inches long was made in the linea alba, beginning about an inch below the umbilicus. When the peritoneal cavity was opened a considerable quantity of ascitic fluid escaped. The tumour was found adherent to the abdominal wall in front and on the left side. The adhesions formed many loculi, which contained fluid, and most of them were readily torn through. The cyst was then tapped, but the contents were too thick and viscid to pass through the tube. An incision was made into it, the edges of which were kept outside the wound to prevent the contents entering the cavity of the abdomen. The solid parts of the tumour were then broken up by the hand, and the mass drawn out. One adhesion had to be ligatured. The tumour sprang from the left ovary. The pedicle was transfixed and tied in two halves by a strong hempen thread. The tumour On was cut off, and the pedicle dropped into the pelvis. introducing a sponge into the peritoneum it was found that it contained neither blood nor cyst-contents. The wound was closed by four deep carbolised silk sutures with intermediate silver sutures ;Lister’s protective was then apsuperficial plied, with a large quantity of loose antiseptic gauze, and a pad of eight folds of gauze having a strip of waterproof between its outer layer. The abdomen having been bandaged, the patient was placed in bed. She was permitted to take lithia-water, ice, barley-water, milk, and a little brandy-and-water in case of sickness. She vomited two or three times during the first three days. The morning following the operation the temperature was normal; 85; respiration 28. The wound was dressed first on thefifth day after operation, and it was almosi entirely healed. It was sweet, and no pus had formed. Ii was dressed again on the eighth day, when it was quit{ healed. The patient recovered without a bad symptom, anc was discharged on the twentieth day after operation. The tumour consisted of one large cyst containing a thick dirty-brown gelatinous fluid, and a mass, forming about two fifths of the whole, composed of a number of cysts with thic1 semi-solid opalescent substance. The fluid removed, togethe: with the ascitic fluid, amounted to two gallons.

temperature

NAIRNE, L.F.P.S. GLASGOW.

AMONGST the means employed for affording relief in obstruction of the bowels are ranked a long flexible tube

(O’Beirnc’s) and rectal bougies. I think a warning with regard to their use is much needed, as the cases in which they can give any beneficial result must be few and far between. So far as my own experience goes, as well as knowlege of cases where they have been used, they have never given any relief at all. Instead, however, of giving relief, there are various conditions of the bowel in which they are productive of the most serious consequences, and that not only in the hands of the inexperienced, but I will venture to say of the most experienced. The condition to which I refer particularly is that of stricture. Where a stricture occurs embracing the free surface of the bowel, it is quite an in-ipossibility to pass a tube through the stricture. The bowel is certain to be ruptured. I have had lately under my care four cases

of obstruction of the bowels. In two of them the tube was used. No relief was afforded in either case. In the last one I held a post-mortem examination, which disclosed the faci that the bowel below the stricture had been punctured ; and to satisfy myself as to the modus operandi I made the follow. ing experiment. A subject being obtained, an artificia: stricture was made at the end of the sigmoid flexure b

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morbomm et dissectionum historias, turn aliorum, turn proprias coliectas habere, et se comparare.—MORAGNIE De Sed. et Cau8. Morb.,lib. iv. Procemium.

MIDDLESEX HOSPITAL. FRACTURE

OF PELVIS

FROM A FALL WHILST CLEANING

WINDOWS ; HEAD OF THE FEMUR DRIVEN THROUGH THE ACETABULUM, BUT NO FRACTURE OF FEMUR ; DEATH ; POST-MORTEM APPEARANCES. (Under the care of Mr. GEORGE LAWSON). IN connexion with the cases of fractured pelvis which were published in the " Mirror " of last week, this case is inter-

esting as an example of a rather rare accident-namely, the driving of the head of the femur through the acetabulum. John D-, aged twenty-one, was admitted into the Broderip ward, under the care of Mr. Lawson, on Feb. 16th, 1878, having just fallen from the second floor of a house, the windows of which he was cleaning, into the area, a height of about twenty feet. He was semi-conscious, could be roused by loud speaking, and greatly collapsed. The right foot was everted, but there was no apparent shortening of the thigh. The thigh could be partially flexed on the abdomen, but any attempt to move the hip-joint caused great pain. There was clearly no fracture of the thigh, but from the pain induced by any movement of the pelvis it was there was probably fracture of the pelvic bones. thought His urine was drawn off to ascertain that there was no iniurv to the bladder or urethra. Feb. 17th.-The patient lies in a semi-conscious state, the slightest movement giving great pain about the pelvis, and he complains of pain in the abdomen. Towards evening the patient became delirious and very noisy. A side splint was applied to the right thigh, without any extension, to keep the parts in a state of rest, with a linseed-meal poultice over the abdomen, and an opiate given by the mouth. From this date the patient gradually drifted from the noisy delirium into a semi-conscious state, in which he could answer questions. He complained constantly of the pain in the abdomen, which was tympanitic. His bowels acted without medicine, and there was no blood in the stools. Gradually he fell into a drowsy delirium, in which he died on Feb. 21st, five days from the receipt of the accident. Post-mortem examination by Dr. CouPLAVD. - Extrems bruising of cutaneous tissues over both hips, right buttock, right shoulder, and right side of the head. On dissection, a large amount of blood was found between the muscles around the hip-joint on the right side. The os innominatuni wa, extensively fractured, the lines of fracture radiating from the centre of the acetabulum, the head of the femur being driven through it, so as to be visible from the inside of the pelvis between the fractured bones. The round ligament was not ruptured, nor was the capsular ligament torn. There was a large quantity of blood effused beneath the

around the bladder, but no rupture of auy pelvic peritoneum and no fracture of ribs or cranial bones. Viscera

viscus,

healthy.